GW1-2021-00666_Well Construction - GW1_20210203

k\ELL CONSTRUCTION RECORD F.,•I ;ng7t DNl1
Ths f nr,:an h- ,,d fl o n.k or nml0pk xdk
I.M ell(,infractor Informa(ion:
14. AtER ZONES
Brian Ewing rRnN In Dewxlr Ft)\
u'.11(n ma,
:a•r Nanu. fn. ft.
4240-B
N( N.0(an1r.low l:mlrcelnn Nmrtcr Ii,OI'TERCASINC fur T!!,k +ed wells OR LINER Y Rcabk
iRON RI nl\\IiTFR TIIICANlS1 11hMNI I
SAEDACCO Inc 0 D, 11' fi. 1.5" iw. NA Steel
16.INNER CASING OR tt'_RING igakrral chnod4aelo
4
• !q \I 0 i0 DL\\IRFR illl(A[fti9 � N11F RI\I.
W ell f nn.tlN(tum Permit X NI0300399 70002483 h. ft. no
ho,aL :lp ,d61 '•...n. , trun" V.er.l ... L'('4AO7601.r,.r ...
1n. f1.
J.Well I rc Mnh h uellaa): -i2 M7I[[N -��---
{{'aI[r Snlgtl\Wlil1 rRlltl 1 TO 214HKFR NATNIi TRI(ANiSS N\TFRI11.
IIARtAuhuml I.INluniapaLAlbhc 11' ft. 19' fl. 1.5" iw. NA NA Steel
I ICxolhcmrd I lleating:Coolim Suppk I I IRmclenlml'Amer S11Kh'leingleI ft. O. ' -
Ilhdosvi;drGmuncroal UResid:nnal%%ater Supph rolaN•dl 18.GROLT
FROM lO r1%URL\[ F\IrLNT VENT N FTIICK,A~1IT
Ellmeatian ft. ft,
Non-Waler Supply Vi'ell: ft. ft
❑Alonucnge ❑Rttorcn
Injrrllun{Veil: ft. ft
I]Aquifer Recharge I I(imnndu:uer Renwolialion 119.SAND 1GRAYEL PACK lit at ltcabkl f
FROM 10 \I 1TF1t11 WWI-14 VMFNT N171109
I Aquifer SrnmGc aid Ran\cn I Nahum Ramcr B ft
❑Aquifer Test FISlommater Ihainagge -
/l. 11.
❑FTltcnmcmal Tahnologn ❑Sabsid_Me('nmml
20.DRR.IJNG LOG 4ans,b a"tional abeef,if nearer,
❑Ocotherual(('luSd Loupl ❑Tracer : FROM I TD DirCRpTION nebr.p,ranvw.na'nri wFr.yr..+r.eM.l
❑GLothemal illeatnte�Cuolhie Remo ®CNlwf lcNlam ultdcr 021 Rnnadsl 0 ft. 19' n.
f1. If. -
4.Date Wellpl Cumplaled: 1/13/21 "ell IDa A21
ft. it.
54-Ndl UwAtkm:
Remediation Management Service Company (1. I1. ,..
fix lbn CT,rcr N:rrc F:x,bn D. ft.
2650 Shenandoah Ave., Charlotte, NC, 28205 -~
Ph,acid.lddress.Cit, ;led 71p r31.RCMARKS l
Mecklenburg 12710204 Temporary injection point through DPT tooling
('worn Pa¢d I,km,ft 1....N. IPOI
5h.I.atfmde and l.nngimdc in tkgrTcrfmitmmrlacenndr or decimal dejfrtr.: 22.Coartirwatiln:
nl xd!fold me all"',n sNll�eiel
35.210533 N -80.801887 _ W Brian Ewing 1/27/2021
1 ���r � Spml Fol(cndxd Weill nirxl r L>Jt
6.h heel the waglisi: Prrmanent ur XTemlgrrlin a, , n,o-•.". r r..,f,.-„vr. r, r, ,. .r , .. d.:,,,�
.r ............,n tnuufnul..,n.l rlx.,.,
?.hthirarrpairto an existiuL'weR: -An or RNo -rt•, "r ,.......t?Ir,,.i:r,r,;.r•,.,.pJ,..,r, .,,.,,,.,,..
e,t., ...„rv•, nli, .,,,,,,,, ,, ,, ,,,n,.o,,,r,•o,.,.r:..•,..,.d..;•r.,.•,r.,, ,r.e,....r n..
r r 2i r.,,.,,,,(,I..IP 1 ., ...r ud,r.,...,. 23.She diagram or additional Nell druilr:
1 oN two use doe bad of(his Inge I(',pro%uli:adddiotml Nell site deiarh or cell
W.Number of walls upoul NTed: 1 coluimclmn details. 1'ou nay also:mach Additional pages it ne essan
1,•,,,.r,.,,w,,.,,.c.e, ,n....-........ a .n,..(r\ll
,,,.,, I S I MUD AL INS'1'UC'TIONS
9.Tonal Nell da•Plh Ink," land Nrrtacr. 19 (O.1 24a. For All W'elh: Submit this Ibnn NI(Inn ?0 loss of conipkuon W Nell
t.., . dr.,,..,d!,r.arb.,,.nr7..,•v:.,.•"14, :oaamcuon to the follouig
In.Static Niter Irsd belux mp of raring: fO.l Di,isim of Water Rnourres,Information PmomAng 1 nil.
o- e.,1, h,,,,,,,,,,,; ,,, , 1617 Nlail Sender Center,Raleigh,NC 27699-1617
11.Drtrehnlediameter.1.5" (in.) 24b. For In kylion Well ONIA; In addilwn 10 sending the loon ks Ile:ddl\�s m
24aabose. also submil a cup% of ihio form Nillun to dass of cumpldtun of xell
12.W ell ennrim-nion tmNhad: DRIVEN :onslmchnn lu the fulloa me
u c anger.r,%.r.eahk d,ml NO,cx
Dh friun,if Water Raaunrcrr.Underground Injrclion Control Pmgrant
FOR NN'ATER SUPPL{'W FLLS ONI.{': 1636 Nlafl Senior Center.Raleigh.SC 27699-1636
NrNmd of tat
24c.For W ater SuDlth d4 Inimlion W'cllc
Vw suborn oce cols of (his form ss ilhrn irl loss o(wmplaimi of
13b.Diainferdnn type: Amount: Nell constmgimi to the county health dcpamttmu of the couin uhme
consmicted
Fam,(A%-I ]rvtll(am6w Upimiem of 6n,ronncni aid Ndnrul hax,uice% D,.xrxmfual(a RrSmrtrts Rn iscd \ugtsl 9,I,